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From:
Sharon Knorr <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Tue, 14 Mar 2000 08:47:42 -0500
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Doing the math, correctly, I hope.....(extrapolating to 100 to start, using their percentages)

For the original screening, if they cultured 100 women with cracked nipples, 54 would be positive for S. aureus and thus included in the study, leaving 46 who were negative for staph.
Of these 54, 25% or 14 women who did not use systemic antibiotics would develop mastitis versus 5% or 3 women who were using systemic treatment.
Thus, of a total of 100 women initially presenting with cracked nipples, 14 of them would avoid developing mastitis if they were being treated with systemic antibiotics.
If all these women were treated with antibiotics upon the initial presentation with cracked nipples, 86% would be receiving systemic treatment which they did not need.
Overuse of antibiotics is one of the reasons why so many people today are colonized with penicillin resistant staph aureus.

That said, it is obvious that systemic treatment is very appropriate, in fact, crucial in some cases where nipple trauma has allowed entry of a pathogen such as S. aureaus into the breast.  How do we isolate these cases and prevent the over-treatment of mothers who may have already been dosed prophylactically during birth or early post-partum, thus increasing the risk of fungal infection?  Are all the women who present with cracked nipples at the Vancouver Breastfeeding Centre now being given systemic treatment?  Should we all be doing a lot more culturing to determine how widespread pathogenic infection has become?  Are any of you in high-use clinics keeping any statistics on mastitis?  I am not seeing enough clients at present to draw any conclusions.  My most recent client with very damaged nipples resolved rather quickly with positioning help and APNO.

I do think that some of these moms are being infected in the hospital.  Many hospital personel are becoming colonized with various strains of resistant organisms.  Infection control through frequent hand washing is extremely important.  Studies have shown that all parts of a hospital room may be contaminated, including furniture and draperies - fix the drapes for a mom and then handle her breasts?? Mom should be encouraged to wash hands as well.  Keeping babies out of nurseries and away from hospital personel as much as possible is one way to cut down on the chances of babies becoming colonized with these bugs.

It was also interesting in this study to see the connection between deep breast pain and mastitis.  I think that in our eagerness to avoid antibiotics, some moms are being treated ad infinitum for yeast infections which may, in fact, be bacterial and amenable to systemic antibiotics.

Looking forward to more discussion on this article.



Warmly,
Sharon Knorr, BSMT, ASCP, IBCLC
Newark, NY (near Rochester on Lake Ontario)
mailto:[log in to unmask]

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